CDI Provides a ‘Safety Net’ for a Safety Net Hospital

The role of safety net hospitals is vital—they provide hundreds of millions of dollars worth of uncompensated care for individuals who need it the most but cannot pay. That means that care delivery and the documentation of that care must be conducted with the utmost efficiency.

Truman Medical Centers in Kansas City, MO, is one such safety net hospital. During the CDI Summit presentation “Revamping CDI to Improve a Safety-Net’s Documentation and CMI,” Seth Jeremy Katz, MPH, RHIA, assistant administrator, information management and execution at Truman Medical Centers, discussed his facility’s quest to overhaul its clinical documentation improvement (CDI) program in an environment where the health system provides $120 million worth of uncompensated care.

Truman has had a CDI program since 2009, when it was operating with subpar software and a promise that it would save the heath system a lot of money, Katz said. The CDI program was run by the system’s quality resources department and had little input from the health information management (HIM) department. According to Katz, nobody trusted the data the program produced, and there was a severe lack of validation and real time tracking of that data.

Then in 2015 with ICD-10 quickly approaching, Katz agreed to take over the CDI program.

Rebuilding from Scratch

Katz’s action plan for his CDI overhaul went like this:

Move CDI under HIM to better align objectives

Implement new software that is integrated with the electronic health record (EHR) and an all-in-one solution

Choose a vendor willing to put “skin-in-the-game”

Ensure program is able to prove CDI impact on a case-by-case basis

One challenge was that Truman outsources its coding to an offshore company. Another challenge is that Truman is a system with 600 beds and Katz’s program consists of three CDI specialists and two physician advisers. For these and other reasons, it was imperative that Katz and his colleagues worked with vendors that integrated a query program with its EHR in order to simplify physician and CDI specialist workflow.

“We’ve started from scratch. Initially, we are where we need to be. CMI is going up, dollars are coming in the door, and we haven’t had to spend as much time rounding and doing education,” Katz said.

As of last month, the CDI department still had a 71 percent query rate, which is an indication they have a long way to go to meet the 20 percent to 30 percent query rate industry standard, Katz said. But he remains optimistic.

One win is that Truman’s EHR vendor helped write a code that sends physicians a page every 48 hours when a query goes unanswered—and it will continue to page them until they respond to a query. Katz said he also got approval to turn unanswered queries into a suspendible offense.